16040 POST THIS CARD NEAR FRONT"OF BUILDING l
PERMIT NUMBER
CITY OF CUPERTI'N0.
16040
INSPECTION DIVISION
JOB INSPECTION RECORD .
,/ `•,103 y0�' PERMIT EXPIRATION.
JOB ADDRESS 100'3 /V. 'o LFe •'L7 UNI _LOT#
• /'') •• PERMIT EXPIRES IF'WORK .
owNER T . /JIS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT..ISSU-
FOUNDATION ANCE,OR 180 DAYS FROM
NOTE: LAST CALLED INSPECTION.
UFER • . ALL GRADING AND DRAINAGE SHALL BE INSTALLED
PR EGUNITE TO COMPLY WITH THE APPROVED PLANS AND CITY OF ; PERMIT VALIDATION
CUPERTINO STANDARDS,
GARAGE SLABS
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
' PLUMBING I /
. ELECTRICAL ISSUANCE DATE
MECHANICAL BLDG EHEC. PLG. MECR. ,
.. DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED w, BUILDING PERMIT
WOOD FLOOR PM INFORMATION
PLUMBING VALUATION '.4 SBFT.
196
MECHANICAL - �+ PERMIT TO -
ELECTRICAL pp�1}��1 �{, - -
FRAMING y1
- Wq'
INSULATION - STo IES - TYPE CONSTR. .
• _ DEC.GROUP .RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF NOTE:NO FINAL INSP,.SHALL BE MADE BEFORE sa.ET FLOoa AReA. TOTAL ACBeAeE
DIAPHRAGM - THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING •RES IND CON PB oo..•,
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. El El O 0 L
ASSESSORS PARCEL NO
ROUGH - SAN.M -
" PLUMBING ELECT. ENERGY
• TUBS&SHOWER PAN PLUMBING ENERGY TRACT No. PARCEL No,
MECHANICAL MECH.ENERGY ACC DATE ACC wLENo 1
ELECTRICAL - BUILDING ENERGY '
FRAMING ' ELECT.,FINAL TEST
?owmc ENG.SITE No.
INSULATION PLUMBING +
GAS TEST GAS -
MECHANICAL 'FIRE SPRINK ENERGY T.2.
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y EI� ED Y E] No,
EXTERIOR SHEAR - ELECTRICAL RELEASE EL000 ZONE -A.L.uc
INTERIOR SHEAR - FIRE DEPT. Y E NL Y LL
SHEETROCK GRADE - FEE SUMMARY
EXTERIOR CATH BUILDING - -
INTERIOR LATH. _ TEMPORARY APPROVALS BUILDING ' "
SCRATCH COAT - ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED'BY BUILDING INSPECTOR. MICROFILM -
ARRANGE FOR.INSPECTION BY PHONING 252-4505, ELECTRIC �+
Lu ONE WORKING DAY BEFORE REQUIRED'INSPECTION."
/ ♦^ . PLUMBING
O� PLEASE GIVE JOB ADDRESS WHEN PHONING.
MECHANICAL
— SEE PERMIT FOR EXPIRATION DATE
I
IMPORTANT! coNsr.TAX
'PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY ;
-
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
-PERMIT NUMBER'
•-' BIILDING PROJECT,I DENTI FICATION APPLICATION $I PERMIT '
R ILDIrvG
11 L �L' � _ BUILDING-ELECTRICAL-PLUMBING-MECHANICAL 16040
NS
OW 's - C� PLAN CHECK VALIDATION
NA QTY. - ELECTRIC PERMIT FEE
• D�iJ �cbD/YiFliJPHDrvE
NorvrR CT
OR OUTLETS-SWITCHES=RECEP 10.00/1.00
L % LIC NO. LIGHTING FIXTURES 10.00/1.00
r�Oq/NprRaESacr°e's //' r/` { APPLIANCES-RESIDENTIAL .4.00
5 PHO/Nr� -) ' PANELS 10.00 PATE OF APPLICATION '.
ARCHITECT PANELS (OVER 200 AMP) 20,00 PLAN CHECK FEE P.C:NO.
ENGINEER -
uc.rv0. ISIGNS TRANS. 3.00.
ADDRESS ENG. SPECIALCIRCUIT 5,00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 2ff.$13 (O
AEMOTORS SEE FEE SCH.
ADDRDDRESSSS
SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION - /
<2U I hereby affirm that 1 am licensed under provisions oCChapter 9 ISSUANCE DATE
¢ a, (commencing with Section 7000)of Division 3 ofthe Business and SLOG- ELECT. PLG., MECH.
H w i Professions Code,and my license is in full ce and effect ❑
z o m Liceusp ass Lic.No e
9 w H w Dute CDN ct q
Q y f J H
¢ ¢ ¢ OWNER-BUILDELARATION BUILDI G PERMIT
S,
w O NFORMATION
X ;
1 . I hereby affirm that I am exCrorn the Contracrni s License MISC.- REFER TO OR
LL Por
O¢ Law for the following reason.(S-7.7031.5.Busmessand Professions VALUATION $/FT.
� - Code:Any city or county which requires a permit to construct,alter, PERMIT ISSUANCE iB69
¢ improve,demolish,or repair any structure,prior to its Issuance,also ELEC.CONTR. LIC.NO. ELEC.
Sa D S, requires the applicant for such permit to file a signed statement that TOTAL
e. w Eau PERMIT TO
he is licensed pursuant to the provisions of the Contractor's License
HZ ¢
Law(Chapter 9(cortmencing with Section 7000)°f Division 3 ofthe ^]�'S� �'�/j-C.
4 o Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
M I-m the basis for the alleged exemption.Any violation of Section 7031.5 'STORIES TYPE CONSTR.
by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER IEA.) 5.00 '
of not more than five hundred doll...($500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECTDEVICE 400 OCC.GROUP BEs.UNITS
their sole compensation,.will do r . .
tile work,and the structure is not -
intended or offered for sale (Scc. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Codes The Contractor's License Law does not apply to an owner of ,
property who build.or Improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SD,FTl FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve-
memsarenotintendedorofferedforsale.If,however,the building GAS-EA.SYSTEM-1,INC.4 OUTLETS 6.00
or improvement is sold within one year of completion,the owner- GAS-EA.SYSTEM-OVER 4 IEA.) 2.00 BUILDING USE
builder will have the burden of proving that he did not build or no- RES IND ' CON PB Other
Prove 1,as owner
of sale.). - INDUSTRIAL WASTE INTER. 30.00 ❑ ❑ ❑ ❑ ❑
❑ 1,as owner of the property,be exclusively contracting with
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS-1 INC 5 V.B. 6.00 ASSESSORS PARCEL No.
and Professions Code:The who
Contractor's License Law docs not apply
to tr owner of property who builds tr improves thereon,and who LAWN SPRINKLERS,-OVER 5(EA.) 1.00 '
contracts for such projects with u conlodor(s)licensed pursuant to
the Contractor's License Law. SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. PARCEL NO.
❑ lam exempt under Sec.' ,B&P.C.Cortin, WATER HEATER W/VENT 6.00 -
reason
Owner Date WATER SYSTEM 5.00 '
ACC.DATE ACF FILE NO.
WORKERS'COMPENSATION DECLARATION WATER TREATING EQUIP." 5.00 1.
I hereby affirm that I have a certificate ofcon.em to sell'-insure, ZONING ENG.SITE N0.
r a certificate of Workers'Compensation Insurance,or a certified _
Opy thereof(Sec.3800,Lab.C.).w - -
Policy No. CoomanY .t" -
0 ❑ Certlf 'o py iuhereby addle FIRE SPRINK ENERGY T-24
❑ Cer' Io o I tl ee city ins ection division.
ZZ Applicant .�/ lL'gip�L MISC.- REFER TO ORD. y ❑ N❑ Y ❑ N❑
f-y - PERMIT ISSUANCE 10.00 FLOODZONE ,A.L.U .
LU 'IFICAT'E
W � COMPEE EXEMPTION FROM WORKERS' C
NSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
CIL Z (T sermon need trot be completed if the permit is for one TOTAL _ Y❑ N❑ Y❑ �N❑
hundred dollars($100)or less.)
U O I certify that in the performance of the work for which this per- OTY. MECHANICAL PERMIT FEE FEE SUMMARY
U
LL mit is issued.I shall not employ any person in any manner so as to
U become subject to the Workers'Compensation Laws of California:
ED Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING
>_ N NOTICE TO APPLICANT: If,after making this Certificate of I,.- -
? emplion,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK - -
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked AIR HANDLING UNIT(TO 10=41F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.EM.) 6.00 SEISMIC FEE. ,
1 hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.CI HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name
Lender's Address HEATI NG UN IT(OV ER 100,000 B.T.U.)9.50 ELECTRIC
I certify that l have read this application and stale that the above VENTILATION FAN (SINGLE) 4.00
information is street I agree to comply with all city and county
ordinances - PLUMBING -
informand sole laws relating to building construction, and BOILER-CCNu1P(3 H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives of this city to enter upon the BOILER-COMP (Over 100,000 BTU)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, Indemnify and keep harmless the City of MISC.- REFEKTO ORD.
Cupertino against liabilities,Judgments, costs and expenses which - CONST.TAX
may Many way accrue against said City in consequence of the PERMIT ISSUANCE 10.00
r ti of[his permit MECH.CONT. LIC.NO. MECH.'
TOTAL TOTAL
gliature of Applicant/Contractor
Date
OFFICE COPY